Influence of the new dispersible fixed-dose combination anti-Tuberculosis drug on treatment adherence among children with Tuberculosis in Osun State, Nigeria.

BACKGROUND: The dispersible fixed-dose combination drug has been recommended as the mainstay of treatment for TB in children. However, more needs to be known about its effect on treatment. This study aimed to assess the effectiveness of the formulation on treatment adherence among children with TB. METHODS: A historical cohort design was used to assess and compare adherences of old loose non-dispersible and new dispersible fixed-dose anti-TB drugs, using a convergent parallel mixed-method approach for data collection. Determinants of treatment adherence were assessed using binary logistic regression. RESULTS: The proportion of children with good treatment adherence was higher in the new dispersible formulation group (82 [64.6%]) relative to the proportion among the loose non-dispersible formulation group (29 [23.4%]). Reports of forgetfulness, travelling and pill burden were significantly higher among those with poor adherence in the loose non-dispersible formulation group. Significant predictors of treatment adherence were acceptability (adjusted OR [AOR]=4.1, p=0.013, 95% CI 1.342 to 12.756), travelling from treatment areas (AOR=8.9, p=0.002, 95% CI 2.211 to 35.771) and forgetfulness (AOR=74.0, p<0.001, 95% CI 23.319 to 234.725). CONCLUSIONS: The determinants of treatment adherence are multifactorial. In addition to ensuring universal access to the drug, flexible referral in case of travelling and ensuring treatment partners' participation to minimise forgetfulness to take pills, are essential.

Prevalence and determinants of lymphedema in newly diagnosed Nigerian breast cancer patients using bioimpedance estimations.

Background: Breast cancer-related lymphedema (BCRL) is common and has significant impact on quality of life. Very little is known about BCRL in sub-Saharan Africa. Generally, BCRL has been mostly evaluated post treatment, with very limited data on the prevalence of pre-treatment BCRL at baseline. This study presents the prevalence and clinical associations of lymphedema among newly diagnosed, treatment-naive breast cancer patients in a Nigerian cohort using bioimpedance estimations. Methods: Consecutively consenting, newly diagnosed, treatment-naive breast cancer patients were assessed for upper limb lymphedema using bioimpedance measurements of the extracellular fluid and the single-frequency bioelectrical impedance analysis value at 5 kHz. Patients were classified as having lymphedema if there was >10% difference in arm measurements or if the ratios of the arm measurements were >3 SD above a normative mean generated from representative controls. Regression analysis was performed to determine clinical variables associated with lymphedema. Results: There were 154 breast cancer patients with a median age of 47 (40.0-56.8) years and a body mass index of 27 (23.5-30.9) kg/m2. The majority (70%) had stage III disease. All measurements were significantly higher in cases than controls. Using various definitions, the prevalence of lymphedema was between 11.7% and 14.3%. Various clinical variables relating to clinical stage were significantly associated with lymphedema. Conclusion: The predominance of locally advanced disease in the Nigerian setting is associated with high pre-treatment lymphedema rates. This may set the stage for higher rates in the post-operative setting. Management of lymphedema should be incorporated into the treatment planning.

The effects of seasonal variations on household water security and burden of diarrheal diseases among under 5 children in an urban community, Southwest Nigeria.

BACKGROUND: Household water security encompasses water-related factors that pose threats to public health at the household level. It presents a reliable access to water in sufficient quantity and quality towards meeting basic human needs. This study assessed the dynamics of seasonal variations in household water security and the association between household water security and diarrheal disease across dry and wet seasons in an urban settlement in Southwest Nigeria. METHODS: A panel study design was employed to study 180 households selected using a multistage sampling technique. The selected households were studied during dry and rainy seasons. Household water security was assessed through the application of the all or none principle to 9 indicators associated with household water security. The intensity of water insecurity was also assessed using the nine indicators. The higher the number of indicators a household failed, the higher the intensity of household water insecurity. The association between the intensity of household water insecurity and the burden of diarrheal disease across the seasons was assessed using the Mantel-Haenszel test. RESULTS: No household was water-secure in both dry and rainy seasons; however, the intensity of insecurity was more pronounced during the dry season compared with the rainy season. Ninety households (52.0%), had water insecurity intensity scores above fifty percentiles during the dry season while 21 (12.1%) households had a water insecurity score above the 50th percentile during raining season, p < 0.001. The burden of diarrheal disease was significantly higher among households with a water insecurity intensity score above the 50th percentile, 9 (8.1%) compared to households with a water insecurity intensity score below the 50th percentile 7 (3.0%), p = 0.034. There was no statistically significant association between the intensity of water insecurity and diarrheal disease burden across the dry and rainy seasons, p = 0.218. CONCLUSION: The high burden of household water insecurity deserves concerted efforts from all concerned stakeholders, a panacea to an important health threat in the developing world.

Colorectal cancer screening with fecal immunochemical testing: a community-based, cross-sectional study in average-risk individuals in Nigeria.

BACKGROUND: The estimated incidence of colorectal cancer is rising in Nigeria, where most patients present with advanced disease. Earlier detection of colorectal cancer is a goal of the Nigerian National Cancer Control Plan, but the utility of fecal-based screening is unclear. This study aimed to assess the fecal immunochemical test as a colorectal cancer screening modality in average-risk individualS in Nigeria. METHODS: A population-based, cross-sectional study of qualitative fecal immunochemical test-based colorectal cancer screening was done in asymptomatic, average-risk participants aged 45-75 years in three states in Nigeria (Osun, Kwara, and Lagos). Participants were invited to enrol using age-stratified and sex-stratified convenience sampling following community outreach. Exclusion criteria included a personal history of colorectal cancer or rectal bleeding in the previous 6 months, a first-degree relative with a known diagnosis of colorectal cancer, or a comorbidity that would preclude conscious sedation or general anesthesia. Participants with positive fecal immunochemical test results underwent colonoscopy, and the positive predictive value of fecal immunochemical testing for colorectal cancer and advanced adenomas (≥10 mm, tubulovillous or villous or high-grade dysplasia) was calculated. Data on demographics and acceptability of fecal immunochemical testing and colonoscopy were collected. FINDINGS: Between January and April 2021, 2330 participants were enrolled in the study and received a fecal immunochemical test, which was returned by 2109 participants. 1677 participants tested negative and 432 tested positive. Of these 432 participants, 285 underwent a colonoscopy (235 showed no polyps or cancer, 47 had polyps identified, and three had colorectal cancer identified). Of the 47 participants who had polyps identified, 20 had advanced adenomas diagnosed. The median age was 57 years (IQR 50-63), 958 (41%) were male and 1372 (59%) were female, and 68% had at least a secondary-level education. Participants were evenly spread across wealth quintiles. The positivity rate of the fecal immunochemical test was 21% overall (432 of 2109; 95% CI 20-21%), 11% (51 of 455; 95% CI 10-12) in Lagos, 20% (215 of 1052; 95% CI 20-21) in Osun, and 28% (166 of 597; 95% CI 27-29) in Kwara. Among the patients with a positive fecal immunochemical test who completed colonoscopy, the positive predictive value for invasive colorectal cancer was 1·1% (95% CI 0·3-3·3), and 7·0% (4·5-10·8) for advanced adenoma. The acceptability of fecal immunochemical screening among participants was very high. INTERPRETATION: Colorectal cancer screening with qualitative fecal immunochemical tests in Nigeria is feasible and acceptable to average-risk asymptomatic participants. However, the low positive predictive value for advanced neoplasia and high endoscopy burden investigating false positives suggests it might not be an appropriate screening tool in this setting. FUNDING: Thompson Family Foundation, Prevent Cancer Foundation, National Institutes of Health/National Cancer Institute Program Cancer Center.

Work Practices and Health Problems of Spray Painters Exposed to Organic Solvents in Ile-Ife, Nigeria.

BACKGROUND: Automobile spray painters in Nigeria are exposed to organic solvents due to the hazardous nature of their work. Inadequate use of personal protective equipment (PPE) may intensify exposure to high levels of chemical hazards with resultant health problems. OBJECTIVES: The present study assessed PPE use and work practices and compared work-related health problems of spray painters and controls in Ile-Ife, Nigeria. METHODS: A cross-sectional study was conducted among 120 spray painters and 120 controls (electronic technicians). Data on socio-demographics, work practices, knowledge about organic solvent-related hazards and self-reported health symptoms were obtained using a semi-structured questionnaire. Clinical examinations were performed for all respondents and the composition of organic solvents in paints and paint products were derived from material safety data sheets. RESULTS: All respondents were male, and the mean age was 32.7±13.8 years for painters and 33.9±15.5 years for controls. Few (7.5%) painters perceived their use of PPE to be adequate. All spray painters worked in enclosed workshops and N-butyl acetate was the most commonly used organic solvent. Spray painters reported excessive tear production, recurrent cough, and short-term memory loss more frequently than controls (P<0.05). In addition, 89% of painters noticed paint-stained sputum immediately after spray painting. The prevalence ratio of respiratory symptoms was higher in spray painters than controls (prevalence ratio=21.0, CI=2.9-153.6). On clinical examination, more spray painters had corneal opacity and dry skin when compared with controls (P<0.05). CONCLUSIONS: Spray painters in the study area worked amidst chemical hazards and had poor use of PPE. Exposure to organic solvents may be responsible for the higher prevalence of self-reported health problems among spray painters. Interventions to enforce the use of PPE and improve the knowledge of organic solvent-related hazards among spray painters are essential. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: Ethical approval to conduct the study was obtained from the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife Nigeria (HREC No: IPHOAU/12/463). COMPETING INTERESTS: The authors declare no competing financial interests.

Neurobehavioral Effects of Organic Solvents Exposure Among Wood Furniture Makers in Ile-Ife, Osun State, Southwestern Nigeria.

BACKGROUND: Furniture making industries are small scale businesses that commonly use organic solvents. There has been minimal focus on the health effects of this chemical hazard on the nervous system among furniture makers in Nigeria. OBJECTIVES: The present study aimed to assess the association between organic solvents exposure and neurobehavioral status of furniture makers, using electronic technicians as a comparison group. METHODS: A comparative cross-sectional study design was employed. A sample size of 108 was calculated for each group. A semi-structured interviewer-administered questionnaire was used to obtain data on the socio-demographic variables and use of personal protective equipment (PPE). A proforma was developed to collect neurobehavioral assessment data. A checklist was used to assess the furniture makers' workshops. Air was sampled from all of the workshops in both the study and comparison groups to determine the concentration of total volatile organic compounds (TVOCs). RESULTS: The use of PPE was poor in both the study and comparison groups, with no significant difference between them (34.4% and 37.7% respectively). Total volatile organic compound and formaldehyde (HCHO) concentrations were significantly higher at the furniture makers' workshops compared with electronic technicians (p<0.001) for both chemicals. The 8-hour time-weighted average of TVOC was also higher in the furniture makers' workshops (4.4±0.6 mg/m3) compared with the control group (0.3±0.3 mg/m3). The neurobehavioral symptoms score was significantly higher among the study group relative to the comparison group (p<0.001). There was a significant difference in the outcome of the auditory verbal learning test, total recall (p=0.005), and delayed recall (p=0.003). There was no significant association between solvent exposure index and findings from the simple reaction time test. CONCLUSIONS: Poor compliance with the use of PPE among furniture makers may increase their exposure to organic solvents. There were more neurobehavioral changes in the furniture makers with a higher exposure index. Measures are needed to educate artisans about workrelated chemical hazards and ensure compliance with basic occupational safety and hygiene standards. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: Ethics approval was obtained from the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University (IPH/OAU/12/1049). COMPETING INTERESTS: The authors declare no competing financial interests.

Environmental Working Conditions, Lung Function and Total Serum Bile Acids of Spray Painters Exposed to Organic Solvents in Ile-Ife, Nigeria.

BACKGROUND: Nigeria has a growing spray painting industry, however, the burden of occupational health problems related to organic solvent exposure among spray painters in Nigeria is under-studied. OBJECTIVES: This study aimed to assess workshop characteristics and ambient concentration of total volatile organic compounds (VOCs) in spray painting workshops and to compare lung function status and total serum bile acid levels of spray painters and controls. METHODS: A cross-sectional study design was employed to survey 120 spray painters and 120 controls (electronic technicians). A semi-structured questionnaire was used to obtain data on socio-demographics characteristics of the respondents. Weight, height and lung function of respondents were measured. In addition, a checklist was used to survey the spray painting workshops. Total VOC levels were determined in 37 spray painting and 31 electronic workshops. Data were analyzed using Statistical Program for the Social Sciences (SPSS) version 20 and a p-value of <0.05 was considered to be statistically significant. RESULTS: Windows were present in only 5 (13.5%) spray painting workshops and 23 (62%) workshops had a retractable tarpaulin at the entrance. Only 9 (24%) workshops had changing rooms, while fire extinguishers and first aid kits were not present in any of the surveyed workshops. A respirator with filter was sighted in only 1 (3%) workshop. The 8-hour time weighted average concentration of total VOCs in spray painting workshops was 13.4 ppm, which is above the national permissible exposure limits of 1.9 ppm. Forced vital capacity (FVC) percent predicted was significantly lower in spray painters (93.9 ±10.8%) than controls (96.7± 8.2%) (t = -2.326, df=238 p< 0.001). In addition, forced expiratory volume in the first second (FEV1) percent predicted was lower in spray painters (94.6±12.2%) than controls (100.3±9.1%) (t=-4.058, df=238, p=0.002). FEV1/FVC% was significantly lower among spray painters (85.48±8.70%) compared with controls (87.88±6.22%) (t=-2.861 df=238, p= 0.005). Total serum bile acids was significantly elevated in painters (8.71±3.39 mmol/l) compared to controls (4.67 ±2.15 mmol/l) (t=10.358, df=213, p<0.05). CONCLUSIONS: Spray painters in the present study conduct their activities in hazardous work settings. More needs to be done concerning workplace regulation and enforcements to ensure that spray painters comply with minimum standards of occupational safety, workplace hygiene and sanitation. PATIENT CONSENT: Obtained. ETHICS APPROVAL: Ethical approval was granted by the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University.